| Department File Number : | M201783762 |
| Claim Number : | FL0399 |
| Date Submitted : | 12/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Physicians Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 11/18/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment was sought for treatment of the eyes | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged use of contaminated needles, syringes, or medication in performing ocular injections resulted in development of endophthalmitis. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged irreversible vision loss | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/18/2015 | 2015CA006336 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/10/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches PA Eastern Pharmacy Inc | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/4/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $41,965 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201676992 |
| Claim Number : | FL0393 |
| Date Submitted : | 2/3/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroupinc.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SALOMON | MELGEN | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 9/19/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient complained that her distance vision was poor and was not getting any better. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Plaintiff alleges negligence in the use of contaminated needles, syringes and/or medication in performing ocular injections resulted in development of endophthalmitis | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged development of endophthalmitis | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/16/2015 | 2015CA001412 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 1/13/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo Retinal Consultants of the Palm Beaches PA Eastern Pharmacy | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 1/25/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $125,629 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201783763 |
| Claim Number : | FL0418 |
| Date Submitted : | 12/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Physicians Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 6/15/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient sought treatment for eyes. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleges use of contaminated needles, syringes, or medication in performing ocular injections led to development of endophthalmitis. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged use of contaminated needles, syringes, or medication in performing ocular injections led to development of endophthalmitis and resulted in permanent injury including permanent and irreversible vision loss. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/31/2015 | 2015-CA-014493 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/1/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/4/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $115,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $33,530 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201783764 |
| Claim Number : | FL0419 |
| Date Submitted : | 12/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Physicians Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 6/15/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient sought treatment for eyes. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient alleges use of contaminated needles, syringes, or medication in performing ocular injections led to development of endophthalmitis | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleges use of contaminated needles, syringes, or medication in performing ocular injections led to development of endophthalmitis and resulted in permanent injury including permanent and irreversible vision loss. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/31/2015 | 2015-CA-014484 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/1/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/4/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $115,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $35,596 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201887353 |
| Claim Number : | FL0398 |
| Date Submitted : | 12/19/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Phy | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 11/18/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment was sought for follow-up of vision | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged negligence in treatment and improperly injecting both eyes with Avastin on the same day. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged negligence in treatment and improperly injecting both eyes affecting vision. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/6/2016 | 2015CA014493 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/12/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches, P.A. | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/19/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $51,576 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201988753 |
| Claim Number : | FL0398 |
| Date Submitted : | 5/14/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 11/18/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient sought treatment for eyes | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged negligence in treatment and improperly injecting both eyes with Avastin on the same day. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged injection of both eyes with Avastin on the same day | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/31/2015 | 2015CA014493 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 3/15/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches, P.A. | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 5/2/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $52,602 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201783766 |
| Claim Number : | FL0457 |
| Date Submitted : | 12/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Physicians Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 4/1/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment sought for eyes. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient alleges substandard care in the use of contaminated needles, syringes and/or medication in performing ocular injectionswhich resulted in ednophthalmitis. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleges substandard care in the use of contaminated needles, syringes and/or medication in performing ocular injectionswhich resulted in ednophthalmitis and irreversible vision loss. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/19/2016 | 502016CA009408 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/28/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/4/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $90,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $32,557 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201783765 |
| Claim Number : | FL0405 |
| Date Submitted : | 12/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SALOMON | MELGEN | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Physicians Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2014 | 2/6/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment was sought for macular degeneration. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleges injuries and damages sustained as a result of ocular injections administered. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged injuries and damages due to ocular injections. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 4/6/2016 | 502016CA003802 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/30/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Vitreo-Retinal Consultants of the Palm Beaches PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/4/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $80,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $24,660 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Department File Number : | M201782163 |
| Claim Number : | FL0403 |
| Date Submitted : | 5/25/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Salomon | Melgen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2521 Metrocentre Blvd. | ||||
| City | State | Zip Code | County | ||
| West Palm Beach | FL | 33407 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 249-000 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME48581 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physicians Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/7/2012 | 2/3/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment was sought for right eye PPV for retinal detachment | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient alleges a breach in the standard of care, resulted in pain and suffering, disfigurement, disability, which is permanent or continuing | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged breach in standard of care resulted in pain and suffering, disfigurement, disability, which is permanent or continuing | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/28/2015 | 502015CA001104 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 5/22/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Solomon Melgen MD PA Vitreo-Retinal Consultants of the Palm Beaches PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| Disposed of by Court | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $28,047 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
Does Dr. SALOMON MELGEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SALOMON MELGEN, MD has at least 11 medical malpractice case(s), lawsuit(s), or complaint(s).